Anesthesia Consent Form

Client Name
Patient Name
Where you can be reached during the day
Is there an alternate number you would like for us to call?
Would you like for us to text or call?

Anesthetic/Surgical procedures to be performed:
Pre-Anesthetic Blood Testing(Required)
It is important to understand that a pre-anesthetic profile does not guarantee the absence of anesthetic complications. It may, however, greatly reduce the risk of complications as well as identify medical conditions that could require medical treatment in the future.

Our greatest concern is the well-being of your pet. We will perform a physical examination before administering anesthesia. However, disorders of the liver, kidneys or blood, are not detected unless blood testing is done.

Abnormalities of any of these may increase anesthetic risk. For these reasons we highly recommend pre-anesthetic blood screens.
Microchip(Required)
Tattoo (only applicable to spays/neuters)
E-Collar(Required)


Authorization to Perform Surgical Procedure and/or Treatments

I, the undersigned owner or owner's agent, of the pet mentioned above the hereby authorize the doctors at Nash County Animal Hospital to perform the above anesthetic and surgical procedure(s) for my pet. I understand that some risk always exists with anesthesia and/or surgery, and that I am encouraged to discuss any concerns about those risks with the attending veterinarian before the procedure(s) is/are initiated.

I understand that Nash County Animal Hospital is not staffed overnight and I accept any risks incurred by leaving my animal overnight unattended. I understand that I have the option to transport my animal to an overnight/24 hour facility if I so desire.

General Information on CPR

Consent/Decline Directive for Cardiopulmonary Resuscitation and Release of Legal Liability

Should, based on the medical judgement of an Animal Diagnostic Veterinarian, my pet require cardiopulmonary resuscitation (CPR) including cardiac compression, positive pressure respiration, emergency drugs, or other heroic interventions, I request or decline that the doctor(s) at Nash County Animal Hospital pursue such medical care as indicated below.
REQUEST CPR
Having requested such emergency procedures, I agree to be held responsible for a resuscitation fee for the services performed while staff members pursue treatment and try to reach me for further directions.

I agree that if the Nash County Animal Hospital staff is unable to reach me within 15 minutes after the initiation of CPR procedures, and after exercising reasonable medical judgment, a veterinarian determines that there appears to be virtually no hope for medical success, the future CPR procedures will cease.

I have been informed by Nash County Animal Hospital and understand that despite the best efforts of the veterinarian and staff at Nash County Animal Hospital, CPR may not save my pet's life. I also understand that even the most successful CPR that restores my pet's life may not allow my pet to regain his/her normal mental and physical health, and thus may leave him/her as invalid.
DECLINE CPR
DO NOT RESUSCITATE MY PET. I have read the above information and release. I agree to the above terms and request that NO CPR BE PERFORMED ON MY PET.
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Nash County
Animal
Hospital

928 Eastern Ave
Nashville, NC, 27856
Phone: (252) 459-4001
Email: nashco@thevetspets.com  

Hospital Hours
Mon - Fri: 7:30 AM – 5:30 PM
Saturday (1st & 3rd Of Each Month)
8:00 AM – 12:00 PM

Closed: Sundays

Cat wearing stethoscope